MEDICARE: KEVIN CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	SUDCI	UT

General Provider Information

NPI Number	:	1720959984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CRUZ

Provider Business Mailing Address
First Line	:	1925 W NORTH TEMPLE UNIT D322
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-4431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 W NORTH TEMPLE UNIT D322
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-4431
Country	:	US
Telephone Number	:	435-354-8499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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Directions to “ KEVIN CRUZ ” Practice Location

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